急性等容血液稀释联合术中控制性降压在外科大手术中的应用

目的探讨急性等容血液稀释（acute normovolemic hemodilution,ANH）联合术中控制性降压（deliberatehypotension,DH）用于外科大手术的临床效果。方法将75例择期行外科大手术患者按随机数字表法分为联合组、降压组和对照组,每组25例。联合组采取ANH联合术中DH措施,降压组采取术中DH措施,对照组按常规处理。观察3组患者动、静脉穿刺置管完成后T0（基础值）、T1（ANH后）、T2（术毕即刻）和T3（术后24h）的血红蛋白（Hb）、红细胞压积（Hct）、血小板计数（PLT）水平的变化情况,手术时间和术中失血量、异体输血量、尿量及输血等情况。结果联合组T2PLT、Hb水平均明显高于降压组和对照组（P〈0.05或P〈0.01）,联合组T0、T1Hb、Hct、PLT水平与降压组、对照组比较差异均无统计学意义（均P〉0.05）,联合组、降压组手术时间均明显短于对照组（P〈0.05或P〈0.01）;联合组术中失血量、异体输血量和输血率均明显低于降压组和对照组（P〈0.05或P〈0.01）,降压组术中失血量、异体输血量和输血率均明显低于对照组（P〈0.05或P〈0.01）,联合组尿量多于降压组和对照组（P〈0.05）,降压组尿量与对照组比较差异无统计学意义（P〉0.05）。结论 ANH与DH联合用于外科大手术可显著减少出血量,不输或少输异体血,不失为围术期血液保护的有效措施。

Application of Combined Acute Normovolemic Hemodilution and Deliberate Hypotension in Major Surgery

Objective To explore the clinical effect of combined acute normovolemic hemodilution（ANH） and deliberate hypotension（DH） in major surgery.MethodsSeventy-five patients undergoing selective major operation were randomly divided into three groups,with 25 patients in each group.The combination group was treated with combined ANH and DH,hypotension group with intraoperative DH,and control group with conventional approach.The hemoglobin（Hb）,hematocrit（Hct）,platelet count（PLT）,operative time,intraoperative blood loss,allogeneic blood transfusion volume,urinary volume and transfusion rate were measured at baseline（T0）,after ANH（T1）,at the end of operation（T2） and at 24 hours after operation（T3）.ResultsThe levels of PLT and Hb in combination group were significantly higher than those in hypotension or control group at T2（P0.05 or P0.01）.No obvious differences in the levels of Hb,Hct and PLT were observed between combination group and hypotension or control group at T0 and T1（all P0.05）.The operative time in combination group and hypotension group were significantly shorter than that in control group（P0.05 or P0.01）.Compared with thypotension group,intraoperative blood loss,allogeneic blood transfusion volume and transfusion rate decreased in combination group but increased in control group（P0.05 or P0.01）.Compared with combination group,urine volume decreased in hypotension and control group（P0.05）.But no significant differences in urine volume were found between hypotension group and control group（P0.05）.ConclusionANH combined with DH can significantly reduce the amount of bleeding and minimize the volume of allogeneic blood transfusion in major surgery.Therefore,the combined application is effective for perioperative blood conservation.